• American Hospital Billing: An Overview

    Business

    The cost of healthcare is perennially a hot-button issue in the United States. Regardless of your stance on who ought to be footing the bill, it’s worth taking the time to learn how the private hospital billing process works. The following is a simple primer on a complicated process: there are a huge number of considerations that go into hospital billing, and many bills pass between multiple firms, sometimes several times each if multiple audits are required. That said, even a simple bill will at least pass through these basic steps.

    Patient Care and Coding

    The first step is always to make sure the patient receives appropriate care. This is handled up-front by the check in process, which performs triage and obtains a basic health history. Then the patient is diagnosed and treated. Once discharged, the billing process begins properly, as the hospital inventories what was done. This creates a “code” …

  • Hospitals Face a Complex Billing Situation in Today’s Insurance Environment

    Business

    Healthcare costs are higher than ever, and providers often find themselves dealing with reimbursements that are less than expected. Hospitals should review their contracts carefully in these cases.

    What Is the Standard?

    The Centers for Medicare & Medicaid Services (CMS) provide a framework for medical reimbursements that many healthcare providers assume will be the norm going forward. However, insurance companies continue to strategically limit their risks by negotiating contracts that may differ from these standards. Executive level managed care expertise is required to negotiate contracts in cases like these.

    Ensure Payment Within Terms

    Healthcare contracts are one thing; getting paid within terms is often another challenge. Your collections department must be on top of trends with your patients and their insurance companies to ensure that you collect as much as possible.

    Code Correctly

    Insurance coding is complex at best. Numerous articles in the popular press have introduced the public to …

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